aVR sign in Brugada syndrome as a marker of life threatening arrhythmic events

A prominent R wave in lead aVR (aVR sign) has been suggested as marker for development of life threatening arrhythmic events in Brugada syndrome by Babai Bigi MA and associates [Babai Bigi MA, Aslani A, Shahrzad S. aVR sign as a risk factor for life threatening arrhythmic events in patients with Brugada syndrome. Heart Rhythm 2007; 4: 1009-1012]. They propose that a prominent final R wave in lead aVR may indicate more right ventricular conduction delay and hence more electrical heterogeneity, which can cause a higher risk of arrhythmia. R wave amplitude of 0.3 mV or more or R/q 0.75 or more have been considered as significant.